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IBA works to reduce risky drinking, but despite significant efforts, regular good quality IBA delivery seems some way off. However there may be some simple ‘nudges’ for supporting IBA delivery that are being overlooked.

IBA itself is not really a ‘nudge’, it is a more conscious and collaborative form of intervention. ‘Nudges’ are more about changing the environment to affect non-conscious decision making. Popular ‘nudge’ examples include placing healthier food choices in more visible places or designing buildings with stairs more accessible than the lifts. In an Amsterdam airport, an image that looked like a fly embossed in the men’s urinals apparently resulted in an 80% reduction in ‘spills’ by focusing the men’s aim! Use of incentives may also be considered ‘nudging’, but there has been lots of debate over what may be ‘nudge’, ‘shove’ or ‘push’.

However, policy and actions to encourage IBA delivery by front-line roles is often in line with ‘nudge’ theory. For instance, incentives and recording systems may mean that screening (identification) tools, like the AUDIT, may pop up on a nurse’s computer screen. Or GP practices collect a payment when offering IBA to new patients when they register.

Incentives may have gone some way to initiating IBA delivery, but have not proved enough in isolation. We need to make front line role’s work environments as conducive to doing IBA as possible. For example, having resources as easily accessible as possible. Having to print off screening tools or leaflets each time is off-putting and time consuming.

Some areas have produced ‘IBA packs’ for front line roles. Packs typically include all the tools and materials needed for IBA and posters or local referral options. Having resources already printed out makes it more likely for roles to initiate IBA and offer appropriate information. Ordering free alcohol materials from the DH orderline is not the easiest of processes.

There could be other ‘nudges’ we are missing out on. In some hospitals all staff have been given a credit card sized lanyard with the three AUDIT-C questions to wear alongside their staff badge. Roles often cite concern over asking patients about their alcohol use. Perhaps wearing a badge stating “I try to ask all patients about their alcohol use” could ease this pressure and remind them about IBA.

Just as reports have found for nudge in general, it’s not the solution, but it may be a part of it.